Mood Disorders
Chapter Five
Introduction
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What is sadness and how does it
differ from a Mood Disorder?
DSM-IV Classifications
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Axis One-Clinical Disorder
Axis Two-Personality Disorder/Mental
Retardation
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Axis Three-General Medical Condition
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Axis Four-Psychosocial and Environment
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Axis Five- Educational Problems
Terms used in Psychopathology of
Depression
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Emotion- state of arousal defined by
subjective states of feeling such as
sadness, anger and disgust.
Affect- pattern of observable behavior
associated with subjective feelings such
as facial expression, tone of voice and
gestures.
Mood- pervasive and sustained emotional
response that can color the person’s
perception of the world
Additional Terms
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Mood Disorders- discrete periods of time when a person’s
behavior is dominated by either a depressive or a manic
mood.
Mania- flip side of depression that involves a disturbance in
mood characterized by elation including inflated selfesteem, euphoria, decreased need for sleep and pressure to
keep talking and racing thoughts.
Unipolar Mood Disorder-behavior is dominated by either a
depressed or manic mood
Bipolar disorder (aka manic depressive disorder)person experiences episodes of mania as well as
depression.
Relapse- return of active symptoms in a person
who has recovered from a previous episode.
Remission-when a person’s symptoms diminish
or improve
Symptoms and Considerations when
diagnosing clinical depression
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Differential symptoms between
Clinical Depression and Normal
Sadness.
Four General types of symptoms.
• Emotional
• Cognitive
• Behavioral
• Somatic
Emotional Symptoms
• Dysphoric (unpleasant) mood
• Diagnostic distinction made between
normal sadness and clinical depression
Severity, quality and pervasive impact of
the depressed mood.
• Anxiety-often a co-morbid diagnosis with
depression
• Manic symptoms-euphoric and energetic
at the beginning of the cycle, changing to
irritable, angry, out of control, selfdestructive.
Cognitive Symptoms
• Slowed thinking, trouble concentrating and
easily distracted
• Pre-occupied with guilt and worthlessness
• Focus attention on the depressive triad:
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Self
Environment
Future
Manic symptoms
 easily distracted by random stimuli and often
respond inappropriately
Grandiose ideas and inflated self-esteem
Quick to anger, argumentative and abusive
Somatic Symptoms
• Sleeping Problems-trouble falling
asleep, fatigue, early morning
waking, spend more or less time
sleeping than usual
• Appetite-changes—eating more or
less than usual
• Libido-loss of sexual desire
Manic-drastic reduction in need
for sleep, extremely energetic
Behavioral Symptoms
• Psychomotor retardation-slowed
movements, may walk or talk as if
they are in slow motion
Manic-gregarious, energetic,
provocative, flirtatious and often
sexually inappropriate.
Classification of Mood Disorders
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Unipolar Disorders
• Major Depressive Disorder
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One or more depressive episodes
No manic or hypomanic episode ( hypomanic episode
is an episode of increased energy that are not
sufficiently severe to classify as full blown mania)
Major Depressive Disorder most often follows a
course of repeated episodes through life
• Dsythymic Disorder
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Depressed mood for at least two years, without
cessation or remission of symptoms for longer than 2
months during this period.
No major depressive episodes during the first two
years.
Bipolar Disorders
• Bipolar I disorder
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One or more manic episodes
Usually accompanied by major depressive episodes in
between manic episodes
• Bipolar II disorder
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One or more major depressive episodes
At least one hypomanic episode
No manic episodes
• Cyclothymic Disorder
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Numerous periods with hypomanic symptoms as well
as periods of depressed mood for at least 2 years.
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No remission of symptoms for longer than 2 months
during the 2 year period.
No major depressive episodes
No manic episodes.
Further Descriptions: Subtypes
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Episode Specifier-specific descriptions of symptoms that were
present during the most recent episode of depression.
melancholia-episode specifier used to describe a particularly severe type of
depression, the presence of which indicates the person is likely to be responsive to
antidepressant therapy or ECT.
 psychotic features- an episodic feature that indicates the presence of
hallucinations or delusions during the most recent episode of mania or depression,
the presence of which usually requires hospitilization.
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Course Specifier-extensive descriptions of the pattern that the
disorder follows over time, as well as adjustment between
episodes.
 rapid cycling-if the person experiences at least four episodes of major
depression, mania, or hypomania within a 12-month period.
 Seasonal affective disorder-onset of episodes is regularly associated with a
change in seasons.
Unipolar Disorder: Outcome, Incidence and
Prevalence & Etiology
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Incidence and Prevalence:
• One of the most common forms of
psychopathology, the lifetime risk of
suffering from this disorder for the
general population is 5%.
• Gender
• Cross Cultural-Universal
• Incidence increasing at earlier ages
(M=45 years)
Unipolar Disorder: Course, Episodes
and Outcome
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Duration
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Episodes
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Recovery
Bi-Polar Disorders: Course and
Outcome
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Onset-usually occurs between the ages of
18-22 years which is younger than the
average age of onset for unipolar
Course and Duration-intermittent. Most
patients tend to have more than one
episode, however the length of time
between episodes is difficult to predict.
Incidence and Prevalence-
Etiology and Theories
Unipolar Mood Disorder
 Social
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Interpersonal loss or separation
Major disappointments dealing with acceptance such as
getting fired
Stressful events
Psychological
• Cognitive Vulnerability: Beck-Depressive Triad
• Theory of Hopelessness
• Interpersonal Perspective
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Biological-Genetic contribution appears to be highest
for bipolar disorder then major depressive disorder and
relatively minor for dysthymia.
Etiology and Theories
BiPolar Disorder
Social Factors
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Increased frequency of stressful life events the weeks
preceding a manic episode.
Schedule disrupting events such as loss of sleep, holidays
Goal attainment events, such as a major job promotion,
acceptance to medical school and graduate school or a new
romance.
Social Environments
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Aversive emotional stress in the family.
Biological-Genetic contribution appears to be highest for
bipolar disorder. Men and women are equally likely to
develop bipolar disorder.
Biological
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Endocrine system
Hypothalamic Pituitary Adrenal Axis
(HPA)
Neurotransmitter Levels
• Serotonin
• Current Neurotransmitter theories
• Bidirectional effects
Treatment- Unipolar
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Cognitive-focus on helping patients
replace self-defeating thoughts with more
rational self statements
Interpersonal Therapy-attempts to
improve the patient’s relationships with
other people by building communication
and problem solving skills.
Antidepressant Medications –Selective
Serotonin re-uptake inhibitors developed
in the 1980’s. They are the most
frequently prescribed treatment, however
medication with other mechanisms of
action are also used.
Antidepressant Therapy
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Selective Serotonin Re-uptake Inhibitors
• Mechanism of action-reuptake pump
• Side Effects
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Tricyclics (Tofranil)
• Mechanisms of action ( Considered 5 drugs in one)
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SRI- reuptake pump
NRI-reuptake pump
Anti-Cholinergic
Alpha 1 antagonists (blocks)
Histaminergic
• Side Effects
• Onset of Effectiveness
• Comparisons of TCA & SSRI
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Monoamine Oxidase Inhibitors-Inhibits the breakdown of NE into
its by-products. Not used as often due to its interaction with
tyrosine which is found in many foods such as cheese, chocolate
and wine which must be completely avoided.
Serotonin Norepinephrine Reuptake inhibitor
Two Very Cute Babies
Treatment-Bipolar Disorders
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Antidepressants-sometimes used in
combination with a mood stabilizer.
Lithium Carbonate-first line treatmenteliminates manic episodes. Large number
of non-responders ( up to 40%)
Anti-convulsants-more effective in
treating rapid cyclers.
Anti-psychotics-sometimes used to
alleviate symptoms of psychosis—not
always present.
Psychotherapy as a treatment
of BiPolar Disorder
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Used as a supplement to medication.
Cognitive Therapy• Interpersonal Therapy-emphasis on
monitoring the interaction between
symptoms and social interaction. Help
patients lead more orderly lives, especially
with regard to sleep wake cycles and work
patterns ( aka-social rhythm therapy).
Suicide
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DSM IV-TR-Classification of Suicide
Four types of Suicide (Durkheim)
• Egoistic suicide-(diminished integration)
• Altruistic suicide-(excessive integration)
• Anomic suicide-(diminished regulation)
• Fatalistic suicide-(excessive regulation)
Etiology of Suicide
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Psychological Factors
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Biological Factors
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Social Factors
Treatment
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Crisis Hotlines
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Psychotherapy
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Medication
• Serotonin Dysregulation
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Involuntary Hospitalization